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HomeMy WebLinkAboutMiscellaneous - 793 SALEM STREET 4/30/2018N_ O Q O O O pO O O - - --_ - ___-_ __`-__ _ _ �~' I�ut� � � K� � �� o n �� � � : -~���=- K/\x/( /-/'�__�/ bau `^�~~- ~`~' ` ` `' ` ^�� um I�o.2�o »" p�uma/wa/wapsoron ,J �� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY I North Andover MA DATE 03-09-2015_ PERMIT # t JOBSITE ADDRESS 793 Salem Street OWNER'S NAME Clarke Harris - _ A OWNER ADDRESS 1793 Salem StreetTEL 978-686-6021 FAX TYPE OR OCCUPANCY TYPE COMMERCIALE] EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: ® RENOVATION: ® REPLACEMENT: PLANS SUBMITTED: YES ® N0E] FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB - ' Vii. - -. _ _.-' � • _';, _ -- I - CROSS CONNECTION DEVICE F-A DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM Jp _ ? '. DEDICATED GREASE SYSTEM - DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM ) . ';' i. i 1.. I ____ _--- _- DISHWASHER _._ ._s'--- _�, _ -. _11 - , ,If DRINKING FOUNTAIN - - — - - FOOD DISPOSER - - - - - ; _ FLOOR AREA DRAIN'i. - - ---- INTERCEPTOR (INTERIOR) -- _ KITCHEN SINK LAVATORY ROOF. DRAIN SHOWER STALL _. _. z SERVICE / MOP SINK _ TOILET i URINAL. WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING- + II 'I A-� i G'id-IER _ , ` I_ INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES 0 NO 0 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY L] OTHER TYPE OF INDEMNITY [j BOND E OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. ` CHECK ONE ONLY: OWNER[—] AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the b t of wl dge and that all plumbing work and installations performed under the permit issued for this application will be in com nce with all Pe ' e r no t Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Gregory K Maffei Sr LICENSE # 10059 SIGNATURE MP 0 JP ❑ CORPORATION © #PARTNERSHIP®# LLC Q# 3451C COMPANY NAME Maffei Plumbing and HVAC LLC ADDRESS 89 Turnpike Rd fy CITY I Ipswich ISTATE Ma ZIP 101938 TEL 978-432-1128 FAXI CELL 978417-9264 1 EMAIL Lgmaffei@maffeiservices.com ' Q r n H °z z 0 m -i m = fR V r ! n � r N y m m rb Cl) o w y i rA WO H. O z 0 Date... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that 06.4nP.. . I ........... ................... .... ......... ............. has permission for gas in tallation .22 U I .. .......................... in the buildings of --11 ...................... ..... . ....................................% ..... I at .........15.Z... .... ... ......................... North And ver, Mas s. Feelo.b..-'.... Lic. No.,.I.(.)--, ...... M.�.................................................. GASINSPECTOR Check #2—E�I� 0 9 -3.5 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - CITY North Andover_ MA DATE 03-09-2015 PERMIT # 0 'J _ JOBSITE ADDRESS 793 Salem Street_— I OWNER'S NAME Clarke Harris . T OWNER ADDRESS '793 Salem Street - _ _ i TEL 978-686-6021 ; FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL .,) PRINT -j ,12 CLEARLY NEW: i RENOVATION: _...I REPLACEMENT: !a PLANS SUBMITTED: YES .-j NO ,vJ APPLIANCES -1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _--1 BOOSTER _._1 CONVERSION BURNER _ _ _ J _ _ -- _ i .— _1 _-- _ -- -� _ __; . -----. J COOK STOVE DIRECT VENT HEATER DRYER --- FIREPLACE FRYOLATOR FURNACE GENERATOR, GRILLE a {{ 'i t . __-_1 -- __ _ __ __ __r { - _-- INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN = - J - —J ---J .__-J _1 POOL HEATER ROOM/ SPACE HEATER ROOF TOP UNIT �. _ , J _� _. _; _ _ .i— TEST j UNIT HEATER_-- UNVENTED ROOM HEATER.} _--j . WATER HEATER OTHER GaS INSURANCE COVERAGE I have"a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES -�J NO R; I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY _! OTHER TYPE INDEMNITY �I BOND J -J OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT ,_! ' SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true accurate to the best of my knowle and that all plumbing work and installations performed under the permit issued for this application will be in co i ce with all Pertinent pro ' ion Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Gregory K Maffei Sr j LICENSE # 10059 1 SIGfATURE MP %' MGF _I JP J JGF_-� LPGI ^ I CORPORATION _;# � PARTNERSHIP i# LLC I# 3451C I COMPANY NAME: Maffei Plumbing and HVAC LLC j ADDRESS 89 Turnpike Road i CITY (_Ipswich _ 1 STATE _MA ±ZIP 01938_ TEL 978_-3_12-6268 - _I FAX I CELL 978-417-9264 EMAIL gmaffei@maffeiserv_ices.com _ o ci x b -n y 0 z 0 y m S m CO) v, a y r_ C) b z t" y t� C O m ,TJ M co m A z m y co ❑ ( e�h (-A<V z ❑ o "t" _ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations c I Congress Street, Suite 100'- Boston, 00'-Boston, MA 02114-20.17 'r= wl<VW.anass.govldia ,. Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly . . t 'Maffei Plumbing+and HVAC LLC. . ` Name (Business/Organization/Iitdividual)' Address: 89 Turnpike Road City/State/Zip: Ipswich, MA'01938 Phone #:978-312-6268 Are ,you an employer? Check the appropriate, box: ' + Type of project (required): I.O l am a cniployer with 9' ` - 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part -tune). 2. ❑ I am a sole proprietor or partner- have,hired the sub. -contractors, listed on the attached sheet., .7. ❑ Remodeling ship and have no employees- _ These sub -contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ .Building addition [No workers' comp. insurance comp. instn-ance.t 5. [+] We are a corporation and its > 10.❑ Electrical repairs or additions fe uircd. 3. ❑q " I am a homeowner doing all "work officer`s have exercised their 'r l l •• ❑ Plumbing repairs or additions ❑ ' myself. [No workers' comp. '• I right ofexcirt tion . MGL p p '" t' • i t2.❑ Roof repairs insurance required.] t c. 152; `1(4),'and ewe have no. •r.. .. ' ` .. l3•❑ - employees. [No workers' a' coind.•insurance reauired.l *Any applicant that checks boa til must als6 till out the section below showing their twbrkers' compensation policy information. + l lomeownerswho submit this affidav'i't indicating they are doing all work imd then hire outside contractors must submitanew. a f7idavit indicating such.. , tConu•actocs that check this box tnust attached an additional sheet showing the name of the sub—,contractors and state whether or trot those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. j - I ane an employer that is prof+iding workers, compensation insurance for racy employees. Below is the. policy rand job site information. insurance Cotn an Name: Hartford p y ' y T 76WEGPY2413 10/22/2015 Policy Mor Self -ins. Lic. #:' ' --Expiration Date: t - . r Job'Site Address: Ciry/state/zip: ANd ,tea ,4Jq 01891 - Attach a copy of the workers' compensation 6olicy declaeation"page (showing the policy number acid expiration date). Failure to 'secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment; as well as'civil penalties in the form of a STOP WORK ORDERxand a fine of up to S250.00 a day against the violator. Be advised -'that a copy of this statement may be foriafded to the Office of Investigations of the -'DIA for insurance covet -age verification. I do herebj> certifj,u der the pains and penalties of pT. r +, �t the information provided -above is trite and correct. _ ' Dat c: U Official use only. Do not write in this area, to -be completed by citj, or town offcial. City or Town: - Permit/License # Issuing Authority (circle one): 1. Hoard of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: ' Information. and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to cant' workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the annrotmate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you• regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant.should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for.future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-7274900 ext 7406 or 1=877-MASSAFE Revised 7-2013 Fax # 617-727-7749 www.mass.gov/dia .q -.COMMONWEALTH OF MASSACHUSETTS JN OF RMAIWN.0; fr COMMONWEALTH OF MASSACHUSETTS SHEET ff TAL 0 9 AS A MASTER -UNRESTRICTED, ISSUES THE ABOVE LICENSE TO: GREGORY K MAFFEI SR 183 HAVERHILL ST ROWLEY MA 01969-2120 6822 10/28/14 265963 \S_ QmRollm mlrs�_•I - STATE OF NEW HAMPSHIRE BUREAU OF BUILDING SAFETY & CONSTRUCTION PLUMBING SAFETY SECTION NAME: GREGORY K MAFFEI SIR yll LIC #:4407 M <=A . EXPIRES: 10/31/2015 Date . t' ........ . O' o? ° TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �9S .A SACH Usf'� rF Lv . S a w p (-�- A This certifies that .. .... ... has permission for gas installation .. ..�.�.......'?... ......... . in the buildings of ............................... at . I'i �'...'? "� ... �" ............ , North Adover, Mass. Fee.. a... Lic. No.) .i..........u GASINSPECTOR Check # 02 a 4231 MASSACHUSETTS UNIFORM APPLICATON FOR PERMPT TO DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations c , �+-P i'�` Permit # Amount $ Owner's Name New Renovation ❑ Replacement ❑ Plans Submitted ❑ M. or type ^l C Name of Licensed Plumber or Gas Fitter CjjgKk one: Certificate Installing Company Corp. ❑ Partner. ❑ Finn/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes El No[] If you have checked M please indicate the type coverage by checking the appropriate box Liability insurance policy E4 Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: S:Anature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the bel+ of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code andnChapter 142 ojthe General Laws. (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumber I a j'I L-1 ❑ Gas Fitter License Number Master ❑ Journeyman Location No. DateZ. Nom,. TOWN OF NORTH ANDOVER Certificate of Occupancy $ � v4A"o,;s <� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Check #� 15756 , s / Building Inspec TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING .kG—s Sn,2 F - BUILDING PERMIT NUMBER: �27: '"h..,; x�yy� •R "a.,s°f DATE ISSUED: SIGNATURE: Building Commissionerff for of Buildings Date SECTION 1- SITE INFORMATION _ 1.1 Property Address: ^ A 1.2 Assessors Map and Parcel Number: OG3 DoB� Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard ReqtIired Provide ReqWred Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 54) r Zone Public ❑ Private ❑ 1.5. Flood Zone Information: Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Punt Address for Service: ? Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone M M X Z O SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 6 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ r� Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: '` C C�/yS T2CcGTcG/v A,) Hoc) S �i 60 c i bf ca, W- —fLj2 i SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar)to be Completed by permit applicant- OFFICL L`IISE 0 ,- 1. Buildingo`er O� (a) Building Permit Fee Multiplier 2 Electrical _ © C:2 (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee tel X (b) (' 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 G o2O — Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner/Authorized Agent of subject property Hereby authorize to act on My beha < 1 i r ative to work authorized by this building permit appli tion. I& 'e -/-& acc� Z Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION e 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/A ent Date IN NO. OF STORIES SIZE BASE1.4ENT OR SLAB SIZE OF FLOOR TUVIBERS 1 2No 3 IM SPAN DIMENSIONS OF SILLS DD ENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. ****************�*************APPPPLICANT FILLS OUT THIS SECTION*********************** APPLICANT �-`���/S PHONE LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) STREET ST. NUMBER ************************************OFFICIAL USE ONLY*********************************** RECOMMENDATIONS Of TOWN AGENTS: E COMMENTS /D Id OD R DATE APPROVED DATE REJECTED TOWN PLANNER DATE APPROVED DATE REJECTED COMMENT FOOD INSPECTOR=HEALTH SEPTIC INSPECTOR -HEALTH COMME DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 I'm SPL e-11 STIZE& r 'r A"ISSY Tb Tye T/TLE IAISUlrOIC WO or Rz 4.v Ttl rAW I&O'Ve "W-Wr 7 -VE ~ If 40e,47WO OAA Mir zar4SANO T//47-/TOGIES ClvAlow elw //(v ,wlTill 7w,- 'R)wN Of NO, ANl�✓4P.20N�.vG e--""rwws ,��.euy.�. JET�C.t'S Feo,,s STC'ECTS COT U•vem r N027 -H fi JN/,OO v FR MI s < �- F�xr.Ycr r.�,rri,�-sem r.V,�r ryes o�-c��.vs is,vvr 6044MO /N r,VE FEGE6'.P,oG FiCAOO iYg2A!'O APER. �iPA�Y/V FQi/P� Sµ/4ivK ON EM -t ' �OM.�ft/NiTY .INGL '� 2SO�YQ C-LR%1k Gro7MIOPApgw Z-9 G -3 � ��/`G' t' ..: -frEP111FA/ .PG. S, i <a�� Tib/S oLANq_�ytf►dSES - ft�oT FDP 8ovvo.PS� � /:0.0:` ,,BQUNOA.PY /.I/FO.P.sf- /NE�P.P�iIlgGf� E".f/6.u/EE.P/.(/6 �'E.Pi�/CES ,4r�ov r,4.rE.y '�xsz-ieiG' .e�cccevs, 66 P4.P,E� .ST.�'EET ►►irr►°t:a"- r! -� aoovE,c, .yt,4ssocvvsErrs oi8io Town of North Andover Building Department 27 Charles Street North Andover, IMA. 01845 D. Robert Nicetta Building Commissioner (978) 688-9545. .;(978) 688-9542 Fax e� HOMEOWNER LICENSE EXEMPTION Please pnnt DATE JOB LOCATION G % 5����L(• �% Number Street Address ,.HOMEOWNER Name Home Phone 'RESENT MAILING ADDRESS715 1/ City Town 9 State Map / lot Work Phone ZiCode The current exemption for "homeowners" was extended to include owner -Occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Persons) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one horse in a two-year period shalt not be'considered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, bylaws, rules and regulations, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements_ HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFIC f Cl) m m m C/) cn 0 CO) 10 � z CD O CL r d O Q =. � o o p a cr d CD O Fw-w-lus. y O. O C7 c O C CA n CD 0 CD CD y. CD CA 0 CD 0 C CD C_ C p _ O -• N O Q N EL Q m y -i =00 m n C) N C")aC O 7m0 Z = S N 01 Im N CL m � O m N p � �= C -00m CD n o .► 0 N• n m � sm • 1( a,��.: VJ m m N Cn m c» . o_a ' n m Om � Co cl J: C C cn °�° - c: 1 CD 1 vp w=9 CD 0 0 O 0 cD cn ky wm� o m cn cn cn �N7� m =: �Z s . 7y c rb C fD O o z nikoo °-L ; aGc a' rf9 C" ►.� o x 'U Z 'i n :Jr o a o a W rCD L y x x H 0 y O C rn 1Z. O O i Date. Z'z ........ e,13 ...... ... ......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............ .............................................................. has permission to perform wiring in the building of ....... .. ............................................................ at ..... ZX32 ..... ........ —4� ..... ................. * ... North Andover, Mass. Fee' ............. Lic. No. ..................................... ELECTRICAL INSPECTOR Check # 4889 of M ?WE e6WeWP7M5XZ?W 09 WXSSXeP?495?7S VO4.M--C S4�af BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Official Use Only Permit No.�O l Occupancy & Fee Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date ' To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to performAe electrical work described below. 1' Location (Street & Owner or Tenant�(�� Owner's Address Is this permit in conjunction with a building permit Yes 6__00, No 0 (Check Appropriate Box) Purpose of Building �/— Utility Authorization Existing Service Amps T. Voitts New Service Z169 Amps % �O Voits Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Overhead 0 Overhead 0 Undgmd 0 Undgrnd J -- No. of Meters _ No. of Meters OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed. Operations Coverage or its substantial equivalent YES = NO have submitted valid proof of same to the Office YES = NO - If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE - BOND a OTHER - (Please Specify) (Expiration Date) Estimated Value of. Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under the Penalties of perjury: FIRM NAME LIC. NO.. . Licensee Signature LIC. NO. Bus. Tel No. Address Alt Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusel General Laws. Adpyt my signat!% on thjS, permit application waives )his requirement. Owner Agent (Please Check one) Telephone No , �j� F / v �K PERMIT FEE (Signature of Owner or Agent) `O P Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above 0 In 0 No. of Lighting Fixtures - Swimming Pool gmd 9 gmd 0 Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total . No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Diposal No. Pumps Tons KW No. of Sounding Devices NoJ of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices 0 Municipal 0 Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed. Operations Coverage or its substantial equivalent YES = NO have submitted valid proof of same to the Office YES = NO - If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE - BOND a OTHER - (Please Specify) (Expiration Date) Estimated Value of. Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under the Penalties of perjury: FIRM NAME LIC. NO.. . Licensee Signature LIC. NO. Bus. Tel No. Address Alt Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusel General Laws. Adpyt my signat!% on thjS, permit application waives )his requirement. Owner Agent (Please Check one) Telephone No , �j� F / v �K PERMIT FEE (Signature of Owner or Agent) `O P The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass.. 0211 9 Workers' Compensation .Insurance Affidavit Name Please Print "L-*?tZK Location:7- c ity 114 #1r_( <-P 0'_1)® IV To .0_/0 Aq_n Phoni 1 am a homeowner performing all work myself. I am a sole proprietor and have no one wworlcing in any capacity F] I am an employer providing workers' compensation for my employees working on this joib. Company name: Address City F 'IPJt J Insurance Co. Policy # Company name: Address. * Failue to segue coverage as required under Section 25A or MGL 152 can kad t&016irtipo uVon afrxirriirra! pemalties of awfit andror one years' imprisorrnentas �eed�s 7 Rema s�osheSam a Sl�P fioe�i€ ( 1llOLt]D)�tt y understand that a. copy of this statement may be forwarded to the Of6ee of Mvestigabons cf the DIA far coverage verification. I do hereby certify under the pars and penalties of poywy bW the Mwmatkw provided above is true and correct Signature Date Print name Pbme-# Official use only do not write in this area to be completed by city or town officiar i City or Town Perrtr7/LK ensing.. CI Building j]Checir jYimmediate response is required Liaensin S6/ectrn Contact person_ Phone #. Health L E] Other ra Official Use Only .+ Permit No. yF�y ?WE &07M07tW5,4Z?W 07 WXSSXeWUS5?7S a�ant.t °d �"` Sakry Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date =l To the Inspector of Wires: ' Town of North Andover The undersigned applies for a permit to performtie electrical work described below. Location (Street & Number. 11 r Omer r orTenant Owner's Address CS Is this permit in conjunction with a building permit Yes 9--' No 0 (Check Appropriate Box) Purpose of Building 14W Utility Authorization No Existing Service Amps' ` -.Vohs Overhead 0 Undgmd 0 New Service 4*-*;' Amps ,i!!�O Voits :� _'kp Overhead 0 Undgmd 11 Number of Feeders and Ampacity Location and Nature of Proposed Electrical No. of Meters No. of Meters _ OTHER: L 17f Z l 3V 7.3 INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO - have submitted valid proof of same to the Office YES = NO - If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE - BOND - OTHER - (Please Specify) (Expiration Date) Estimated Value of. Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under the Penalties of perjury: FIRM NAME LIC. NO. Licensee Signature LIC. NO. Bus. Tel No. Address Att Tel. No. OWNER'S INSURANCE WAIVER: 1 am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusel /, General Laws. t my signature on thi permit application waives h7rirement. Owner Agent (Please Check one) Z 4 Telephone NoY `7 =y0' _ PERMIT FEE (Signature of Owner or Agent) 40,9.? Total No. of Lighting Outlets 1 No. of Hot fuse No. of Transformers KVA Above 0 In 0 No. of Lighting Fixtures Swimming Pool grnd 0 gmd 0 Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Diposal No. Pumps Tons KW No. of Sounding Devices NoJ of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices 0 Municipal 0 Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wirin No. Hydro Massa a Tuds No. of Motors Total HP OTHER: L 17f Z l 3V 7.3 INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO - have submitted valid proof of same to the Office YES = NO - If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE - BOND - OTHER - (Please Specify) (Expiration Date) Estimated Value of. Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under the Penalties of perjury: FIRM NAME LIC. NO. Licensee Signature LIC. NO. Bus. Tel No. Address Att Tel. No. OWNER'S INSURANCE WAIVER: 1 am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusel /, General Laws. t my signature on thi permit application waives h7rirement. Owner Agent (Please Check one) Z 4 Telephone NoY `7 =y0' _ PERMIT FEE (Signature of Owner or Agent) 40,9.? 34 oVC- 1�ovy,cf Dlt G_ f_O:5, / ,JrM • • Date.. i-!— nZ TOWN OF NORTH ANDOVER .. . of p PERMIT FOR PLUMBING Thi certifies that ..(� a W t .. �.� ..... ................ has permission to perform ...� .. �� !4 plut'hbing in the buildings of ...^ r S ........................... at .... �.q 3... �'�. .... � ....... North Andover, Mass. Fee.. PLUMBING INSPECTOR Check # 5449 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building Location/' .7 �� ��� �. Owners Named Permit # �-' Amount Type of Occupancy New 13, Renovation E] Replacement ❑ Plans Submitted Yes ❑ No ❑ FIXTURES (Print or type) Installing Company Name Address Check one: Corp. Partner Certificate rsusmess ielepnone r -17V.— 17 fi -7 Lj Firm/Co. Name of Licensed Plumber: Insurance Coveraee: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy n Other type of indemnity El. Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above threeinsurance Signature .4 Owner ❑ Agent ❑ I hereby ceaify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my ki owledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbi b Code a Chapter Ief e General Laws. By: rgna ure o1 i-Wensuu r1unjuca Type of Plumbing License Title �1 % Lt City/Town rcense NumDer Master Journeyman ❑ APPROVED (OFFICE USE ONLY FA